Healthcare Provider Details

I. General information

NPI: 1871730937
Provider Name (Legal Business Name): MAGED S TAWADROS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2009
Last Update Date: 08/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 N ALTADENA DR # F
PASADENA CA
91107-3364
US

IV. Provider business mailing address

PO BOX 1183
TEMPLE CITY CA
91780-1183
US

V. Phone/Fax

Practice location:
  • Phone: 626-728-1708
  • Fax: 626-294-9414
Mailing address:
  • Phone: 626-728-1708
  • Fax: 626-294-9414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License NumberRHF 76752
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: